Pertussis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*The mainstay of treatment of pertussis is antibiotic therapy. | *The mainstay of treatment of pertussis is antibiotic therapy.</ref><ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814 }} </ref> | ||
===Timing=== | ===Timing=== | ||
| Line 13: | Line 13: | ||
*Clinicians should strongly consider treating prior to test results if clinical history is strongly suggestive or patient is at risk for severe or complicated disease (e.g., infants). | *Clinicians should strongly consider treating prior to test results if clinical history is strongly suggestive or patient is at risk for severe or complicated disease (e.g., infants). | ||
*If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis. | *If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis. | ||
*It is recommended to treat persons older than 1 year of age within 3 weeks of cough onset and infants younger than 1 year of age and pregnant women (especially near term) within 6 weeks of cough onset. | *It is recommended to treat persons older than 1 year of age within 3 weeks of cough onset and infants younger than 1 year of age and pregnant women (especially near term) within 6 weeks of cough onset.</ref><ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814 }} </ref> | ||
===Antimicrobial Regimens=== | ===Antimicrobial Regimens=== | ||
:* '''1.''' '''Whooping cough''' | :* '''1.''' '''Whooping cough'''</ref><ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814 }} </ref> | ||
::* '''1.1.''' '''Adults''' | ::* '''1.1.''' '''Adults''' | ||
:::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days | :::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days | ||
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::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days (maximum dose 1 g/day) | ::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days (maximum dose 1 g/day) | ||
::::* Preferred regimen (4): [[Trimethoprim-Sulfamethoxazole]] 8/40 mg/kg/day PO bid for 14 days | ::::* Preferred regimen (4): [[Trimethoprim-Sulfamethoxazole]] 8/40 mg/kg/day PO bid for 14 days | ||
:* '''2.''' '''Post exposure prophylaxis'''<ref>{{ | :* '''2.''' '''Post exposure prophylaxis'''</ref><ref name="pmid10609814">{{cite journal| author=Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L et al.| title=Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study. | journal=Lancet | year= 1999 | volume= 354 | issue= 9196 | pages= 2101-5 | pmid=10609814 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10609814 }} </ref> | ||
::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis | ::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis | ||
::* Click [[Pertussis secondary prevention|here]] to learn more about postexposure prophylaxis. | ::* Click [[Pertussis secondary prevention|here]] to learn more about postexposure prophylaxis. | ||
Revision as of 17:09, 14 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]
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Pertussis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pertussis medical therapy On the Web |
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American Roentgen Ray Society Images of Pertussis medical therapy |
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Risk calculators and risk factors for Pertussis medical therapy |
Overview
Early management of pertussis is very important. A reasonable guideline is to treat individuals aged >1 year within 3 weeks of cough onset and infants ages <1 year and pregnant women (especially near term) within 6 weeks of cough onset. The preferred antimicrobial agent for treatment of pertussis is either Azithromycin, Clarithromycin or Erythromycin. Trimethoprim-sulfamethoxasole can be used in those patients who are unable to tolerate macrolide antibiotics. An alternative drug to Azithromycin may be administered to those who have known cardiovascular disease.[1]
Medical Therapy
- The mainstay of treatment of pertussis is antibiotic therapy.</ref>[2]
Timing
- Early treatment of pertussis is very important.
- The earlier a person, especially an infant, starts treatment the better. If treatment for pertussis is started early in the course of illness, during the first 1 to 2 weeks before coughing paroxysms occur, symptoms may be lessened.
- Clinicians should strongly consider treating prior to test results if clinical history is strongly suggestive or patient is at risk for severe or complicated disease (e.g., infants).
- If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis.
- It is recommended to treat persons older than 1 year of age within 3 weeks of cough onset and infants younger than 1 year of age and pregnant women (especially near term) within 6 weeks of cough onset.</ref>[2]
Antimicrobial Regimens
- 1. Whooping cough</ref>[2]
- 1.1. Adults
- Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
- Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
- Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days
- Alternative regimen (intolerant of macrolides): Trimethoprim-Sulfamethoxazole 320/1600 mg/day PO bid for 14 days
- 1.2. Infants <6 months of age
- 1.2.1. Infants <1 month
- Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
- Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
- Note: Trimethoprim-Sulfamethoxazole contraindicated for infants aged < 2 months
- 1.2.2. Infants of 1-5 months of age
- Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
- Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
- Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
- Alternative regimen (for infants aged ≥ 2 months): Trimethoprim-Sulfamethoxazole 8/40 mg/kg/day PO bid for 14 days
- 1.3. Infants ≥6 months of age-children
- Preferred regimen (1): Azithromycin 10 mg/kg PO single dose THEN 5 mg/kg PO qd for 2-5 days (maximum dose 500 mg/day)
- Preferred regimen (2): Erythromycin 40-50 mg/kg PO qid for 14 days (maximum dose 2 g/day)
- Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days (maximum dose 1 g/day)
- Preferred regimen (4): Trimethoprim-Sulfamethoxazole 8/40 mg/kg/day PO bid for 14 days
- 2. Post exposure prophylaxis</ref>[2]
- Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
- Click here to learn more about postexposure prophylaxis.
References
- ↑ Pertussis (whooping cough). Treatment. CDC.gov. Accessed on June 15, 2014
- ↑ 2.0 2.1 2.2 2.3 Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L; et al. (1999). "Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study". Lancet. 354 (9196): 2101–5. PMID 10609814.